Akıllı Kadınlar İçin DEHB (ADHD for Smart Ass Women)

The original title is ADHD for Smart Ass Women. It was published in December 2023 by William Morrow, an imprint of HarperCollins. Its subtitle promises to teach the reader to fall in love with their ADHD brain.

Tracy Otsuka is a lawyer with a law degree and a master's in law, and a certified ADHD coach. Her background includes working as an enforcement attorney for the US Securities and Exchange Commission, high-end women's clothing design, and real estate brokerage. She has a widely listened-to podcast with the same name as the book and a large online community. The story of her own diagnosis is also part of the book's material.

The Turkish edition came out from Mabel Kitap as Akıllı Kadınlar İçin DEHB: Farklı Olduğunuzun Farkında mısınız?, translated by Eren Kanat. I saw the details on Kitapyurdu and D&R. In the Turkish title the slang and the know-it-all-woman joke of the original name are lost; it is worth knowing this to guess the tone of the book.

What you need to know first

Otsuka is not a clinician, and she says so openly herself.

The book is a coach's book. It feeds on coaching sessions she has done with thousands of women, the stories of women she talked to on the podcast, her own experience, and the research she has read.

This is not a bad thing. But a coach's view and a clinician's view do not look from the same place. Coaching certificates are not regulated like clinical licenses. On diagnosis, co-occurring conditions and treatment, a coach's word carries limited weight. I took up this distinction in more detail in the article what is ADHD coaching.

While reading the book I had to keep asking myself which sentence came from research and which from a coaching session.

What the book says

It consists roughly of two halves.

The first half: understanding ADHD anew. Why women are overlooked, how ADHD looks in women, a framework for how the brain works, rejection sensitivity, difficulty with emotion regulation, its relationship to trauma, relationships and social skills.

The second half: strategies. Planning, setting up external reminders, starting and finishing tasks by using the brain's need for reward, procrastination, eating, spending and sleep.

The language is plain, the sentences are short, anecdotes are plentiful. Publishers Weekly assessed the book as a solid starting point for those just beginning to learn about ADHD. I agree with this description: a starting point.

What it does well

It catches the reader from a familiar place. The women's stories in the book are full of the kinds of experiences women with ADHD often describe: brilliant ideas and unfinished work, symptoms mistaken for something else for years, looking successful from the outside while being worn out inside. While reading I caught myself a few times.

It does not skip the emotional side. Although difficulty with emotion regulation is not in the DSM criteria, it is very common in adults with ADHD and one of the aspects that strain life most. The book gives this subject serious space.

Its strategies on external structure and reward are reasonable. Making the task visible outside, marking time from outside, tying finishing a job to a small reward that comes right away. These are approaches in line with what we know about motivation and reward sensitivity in ADHD. The book presents them in a way the reader can adapt to their own life.

It reduces shame. In the period after diagnosis, the energy of this book can do a person good. For someone who has felt lacking for years, it is valuable that somebody says "there is nothing wrong with you" so enthusiastically.

The superpower question

My real objection to the book starts here.

Otsuka puts the positive sides of ADHD at the center of the book: optimism, tireless hyperfocus on a subject of interest, creativity, thinking outside the box, an entrepreneurial spirit. She objects to the word "disorder," because she thinks it implies only a flaw. She also opposes the idea that ADHD is an attention deficit, because the same person can both scatter and focus for hours.

This second objection is justified and not new. Both Barkley and Hallowell describe ADHD as a difficulty in regulating attention more than an absence of it.

But the first objection leads somewhere else. Part of the diagnostic criteria is that symptoms cause a real loss of function in life. The 2021 consensus statement of the World Federation of ADHD shows that untreated ADHD is associated with measurable negative outcomes in education, work, accident risk and health.

Presenting ADHD mostly as a source of power has costs that I have written about many times on this site. Asking for accommodations at work or at school rests on the acceptance of difficulty. A reader who is not doing well carries, on top of that, the burden of "why can't I use my superpower." I discussed this at length in the article the question of strengths in ADHD.

A note on hyperfocus too: research on this concept is limited, and hyperfocus has not been shown to be specific to ADHD alone. What is presented in the book as a power often means, in real life, forgetting to eat, to sleep and to show up for an appointment.

To be fair: Otsuka does not deny the difficulties; half of the book is about them anyway. The problem is in proportion and tone. The positive frame is so dominant that the difficulties can be read as a transitional stage.

Figures and explanations

This is where I stopped most while reading.

Seventy-five percent. In the English promotion of the book and in the promotional text on the sales pages of the Turkish edition, it is said that seventy-five percent of girls and women with ADHD go undiagnosed. I could not clearly find which study this figure comes from. In reader reviews too, the criticism that some of the book's statistics are given without sources comes up often. It is true that ADHD is overlooked in women; both the 2014 review by Quinn and Madhoo and the 2020 consensus statement by Young and colleagues show this. But giving an exact percentage means claiming more than the data we have.

Dopamine. The book leans heavily on a dopamine explanation when describing ADHD. The dopamine system holds an important place in ADHD, and the effect of stimulant medication is related to it. But ADHD is a picture in which many genes and more than one brain network play a role. Tying everything to dopamine is an understandable simplification, but it is a simplification.

Rejection sensitivity. The book gives rejection sensitivity an important place and also treats it as a trauma response. An intense emotional reaction to rejection is an experience many adults with ADHD recognize. But "rejection sensitive dysphoria" is not a diagnostic category and research on it is still scant. Explaining it as a trauma response is more an interpretation than a proven finding. I looked at the subject from a more cautious place in the article rejection sensitive dysphoria.

Trauma and ADHD

The book also takes up trauma, and it describes how, when ADHD and trauma are present together, they can be related to rumination, depression and anxiety.

This co-occurrence is also seen in research. It is known that children with ADHD are more exposed to adverse experiences, and that trauma can produce pictures resembling ADHD symptoms.

But one has to be careful in this area. The claim that trauma causes ADHD does not fit with the high heritability of ADHD, and popular books that put this claim at the center receive serious criticism in the field. While reading Otsuka's book, in places such as where she explains rejection sensitivity as a trauma response, I felt that the line between the two concepts was blurring.

How trauma and ADHD are told apart and how they can be addressed together is a subject to be discussed with a clinician rather than found in a coach's book.

The title question: smart women

The slang in the original title carries a joke like "know-it-all woman." In Turkish this joke has been flattened into "smart women."

Both titles imply something: the book addresses especially intelligent, talented and undiagnosed women. This is a partly justified target. High intelligence can mask ADHD for a long time, and these women are often among those who get the diagnosis latest.

But the title also produces a side effect. The importance of ADHD can be read as though it depended on how intelligent the person is. ADHD is seen at every level of intelligence, and its difficulties are real in all of them.

This is a title choice and does not determine the content of the book by itself. But it is a good clue for thinking about whom the book addresses and whom it may leave out.

The promotion of the book includes praise from well-known names in the field such as Edward Hallowell. This gives an idea of how the book was received in the field but is not a guarantee of the accuracy of the content.

Privilege and promotion

There are two more criticisms, and both come up often in reader reviews.

Some suggestions assume a certain income level. Hiring help for housework, handing off childcare, buying expensive devices. These suggestions may work but are not within reach for a significant share of readers.

The book often refers to the author's other work. The podcast, the online community, the programs. It is natural for a coach to talk about her own work. But the frequency of these references made the book feel to some readers like a promotional brochure. I felt that at times too.

There is also a balance problem that readers have noticed: a significant part of the stories in the book come from high-energy, successful, entrepreneurial women. Women who experience quieter, inattentive-type ADHD may find themselves less in it.

On medication

I would not recommend anyone make a decision about medication from a coach's book. The decision about medication is made with a doctor. This book should not be the main source to turn to for forming an idea about treatment.

For whom, and at what stage

For women who suspect ADHD or have just been diagnosed and have never read a book. For those looking for an easy introduction and an experience of recognizing themselves.

For those who listened to the podcast and liked it and want a more collected text. The book is like a written summary of that world.

For those facing the emotional side for the first time. The chapters on emotion regulation and rejection offer a beginning.

Whom I would not recommend it to: someone who has a serious loss of function in daily life and has not yet addressed it with treatment; the enthusiasm of this book may give the wrong message in that case. Someone looking for a book that cites sources. Someone who lives with an inattentive-type, inward-turning picture and knows they will not find themselves in the high-energy entrepreneur stories.

How to read it

With a pen and a little suspicion.

The chapters describing how ADHD looks in women and the strategy chapters are the most useful parts of the book. When reading the places where the superpower emphasis intensifies, it is good to step back a pace and be curious about the source of the figures given.

It is around three hundred pages but reads quickly. It makes sense to read it once and return to the strategy chapters later.

As a second book, reading one with a clinical foundation that gives sources will balance the gaps of this one.